Central Line ocluded or sluggish?

Nurses Safety

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Can you all let me know what you do if a central line is blocked or sluggish.

what is the assessment you go though and what interventions would you do prior to calling the Dr.?

I am looking to see if we have a common practice for this or does everyone do a different thing?

P.S. Would appreciate if you can send me a protocol checklist if possible

Thanks

Amyna

Continous heparin flush can actually cause HIT in patients - more than not flushing with heparin. This is why the practice is discourage... Heparin Lock however is used on Portacaths, and stongly adviced. Just think about it, if you are to get an IV dose of heparin 10cc every 8 hours in 3 ports that would be 30cc of 1/1000cc heparin. This is assuming that the nurses only did flush once with heparin on that shift. Since the protocol of the hospital is to flush with heparin more than likely it has been used more than 1X.

Specializes in Telemetry, CCU.

What do you folks think about a possible erosion of the vein? I am a new nurse and scared about doing anything that will cause further harm to the patient (of course who isn't?) and I remember reading in my critical care skills book that sometimes the catheter can wear away the lumen of the vein and cause an erosion. If this happens, the distal port will be blocked and you won't get blood return or be able to flush it. Now lets say we keep flushing with saline, then heparin, then get an order for Cathflo, we're doing all these things and just ruining the poor vena cava. We could even cause a patient to bleed out in this case.

Has anyone ever heard of a vena cava erosion or extravasation of a central line or is this extremely rare?

Specializes in Vascular Access.
What do you folks think about a possible erosion of the vein? I am a new nurse and scared about doing anything that will cause further harm to the patient (of course who isn't?) and I remember reading in my critical care skills book that sometimes the catheter can wear away the lumen of the vein and cause an erosion. If this happens, the distal port will be blocked and you won't get blood return or be able to flush it. Now lets say we keep flushing with saline, then heparin, then get an order for Cathflo, we're doing all these things and just ruining the poor vena cava. We could even cause a patient to bleed out in this case.

Has anyone ever heard of a vena cava erosion or extravasation of a central line or is this extremely rare?

If you are asking "Can a Central line infitrate?" then the answer is YES,

However, keep in mind that though the vessel wall can break down, allowing for the permiability of infusates to leak out of the vein, or the vessel may erode through the wall, it isn't an every day event.

Why? Well the SVC (where catheter's that are centrally placed terminate) is a large vessel that receives blood from the subclavian vessel which has a blood flow of approx. 2L/min. Therefore, vesicant medications (those that do the most damage to the tunica intima) are diluted quite well which helps to protects these smooth endothelial cells.

However, you do not have that same blood flow in your distal extremities and the injury to those cells intensifies with the extremes in pH or osmolarity of your infused med.

In over 20 years of Nursing, I've never had a Central IV catheter blocked because it has eroded through the vessel and I'm "steadily" instilling a fibrinolytic agent" causing further damage to the vessel.

Stay inquisitive and remember that a "healthy fear" will aide in preventing mistakes.

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